Acid reflux is something I see A LOT in my practice. It is one of my favorite topics and things to treat (if you have ever seen me as a patient then you have likely seen me geek out about the importance of stomach acid).
Approximately 36% of Americans are diagnosed with GERD (gastroesophageal reflux disease) which means even more suffer from symptoms but have not been diagnosed making it EXTREMELY common.
GERD is caused by decreased tone in the lower esophageal sphincter (LES), which is the door that allows food from the esophagus into the stomach. So food enters in our mouths, travels down the esophagus and through the lower esophageal sphincter into the stomach. The LES should act like a trap door- allowing food in when pressure is exerted on it but preventing back flow (reflux) once it has passed through.
So what causes decreased tone of the lower esophageal sphincter? Several things:
Low stomach acid
Certain medications, especially those that relax smooth muscles and those that treat acid reflux (I know, I know, more on this to come)
Tobacco use
Pregnancy
Scleroderma
Diabetes
Chronic overeating, which leads to stretching of the muscle.
What keeps the lower esophageal sphincter tone:
Stomach acid (say what?!)
So now you may be thoroughly confused. Stick with me. We have a big misconception in this country that having too much acid in the stomach causes acid reflux. There is also a notion that we can be too acidic overall. However, it’s very difficult to talk about the body as a whole as being overly acidic. This is because different parts of the body have VERY different pH requirements, each lending to its essential role in our physiology. For example, the pH of the stomach should be as low as 1.5 while the pH in the colon is closer to 7. (the lower the pH the more acidic).
That lower esophageal sphincter stays closed by having enough stomach acid. When it is able to dilate or open, we experience reflux of stomach contents into the esophagus. This does not feel good. See the stomach lining is built tough- designed to deal with all those gastric juices and low pH. The esophagus is not.
Stomach acid has many beneficial properties:
It is an important step in early digestion and the breakdown of food.
It aids in the absorption of vitamins and minerals, especially iron, zinc, B12, vitamin C, and magnesium
It helps to kill off any harmful toxins in food.
It maintains a healthy bacterial balance and prevents overgrowth of our good gut bacteria.
It triggers the gallbladder to release bile and the pancreas to release digestive enzymes (both of which aid in the breakdown of fats, carbohydrates, and protein)
It ensures timely emptying of the stomach so that food can move on to other parts of the GI tract (when it doesn’t we can experience a variety of symptoms including gas, bloating, and constipation).
So what causes low stomach acid?
Stress
H pylori infection
Abuse of toxins and alcohol
Autoimmune gastritis (10% of all GERD cases)
GERD medications
How do we treat GERD conventionally?
We treat GERD conventionally with a class of drugs called proton pump inhibitors, or PPI’s. These are some of the most common drugs prescribed in America and they are also available over the counter making them a $13 billion/year industry. They are so common that most people will recognize their names: Nexium, Protonix, Zantac Prilosec, Previcid.
These drugs are designed to be used for a period of 6-8 weeks to allow the healing of peptic ulcers. 6-8 weeks! Why such a short time? Because they are associated with a list of serious side effects. Now don’t get me wrong, I use PPI’s to treat patients with acute ulcers but many people have been taking PPI’s for YEARS and this is how they are commonly recommended to be used by healthcare providers.
PPI’s will help with symptoms while the patient is taking them. Generally, as soon as the patient discontinues use, they experience rebound acid reflux. Why? Because we have spent all this time blocking the production of stomach acid. So when we take the PPI away, that lower esophageal sphincter is not tone and allows for the reflux of stomach contents.
There are other risks of taking PPI’s long term including:
Iron deficiency anemia
Vitamin B12 deficiency
Magnesium deficiency
Zinc deficiency
Calcium deficiency
Risk of bone fracture (due to decreased calcium absorption)
Rhabdomyolysis
Bacterial overgrowth/ dysbiosis
Pneumonia
C. Diff
Thrombocytopenia
In a nutshell, we need to address acid reflux by removing barriers to cure and restoring normal digestive functioning. I have had so much success treating acid reflux naturally. As with all things in natural medicine, treatment will look a little different for all patients but some common interventions include:
Using demulcent herbs to soothe the esophagus
Replacing stomach acid
Supporting the stomach to produce more acid on its own
Managing stress
Removing dietary triggers
Addressing dysbiosis (overgrowth or undergrowth of beneficial bacteria)
Identifying and correcting food sensitivities